Iwase Takeshi, Mikoshiba Yuji, Ra Eimei, Yamamoto Kentaro, Ueno Yoshitaka, Terasaki Hiroko
Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Medicine (Baltimore). 2019 Jun;98(24):e16062. doi: 10.1097/MD.0000000000016062.
To evaluate the changes in the blood flow on retina and the optic nerve head (ONH) after conventional laser treatment and to compare it to that after patterned scanning laser (PASCAL) treatment in patients with severe nonproliferative diabetic retinopathy (S-NPDR).In this prospective, cross-sectional study, the blood flow on retina and the ONH was assessed by laser speckle flowgraphy using the mean blur rate (MBR) in 39 eyes with S-NPDR before, 1, 4, 8, 12 weeks after panretinal photocoagulation (PRP). Of 39 eyes, 17eyes with 17 patients treated by conventional laser and 22 eyes with 22 patients treated by PASCAL.The mean age was 55.5 ± 11.5 years in the conventional laser group, 55.6 ± 11.8 years in the PASCAL group. The MBR-vessel, which can be dominantly expressed as retinal blood flow, was significantly reduced after PRP treated by conventional laser (P < .001), but did not change after PRP treated by PASCAL. The ratio of MBR-vessel to the baseline was significantly lower in the conventional laser group only at Week 1 (P = .045). The MBR-tissue, which can be dominantly expressed as the ONH blood flow, did not significantly change after PRP in the both group. The multiple stepwise regression analysis revealed that the laser burns was an independent factor significantly correlated with the ratio of MBR-vessel at Week 1 to the baseline (β = -0.550, P = .012).The retinal blood flow was significantly reduced during the 12 weeks only after completion of PRP by conventional laser treatment. Our results indicate that short pulse on PRP treatment performed by the PASCAL would not significantly reduce the retinal blood flow.
评估重度非增殖性糖尿病视网膜病变(S-NPDR)患者接受传统激光治疗和图案扫描激光(PASCAL)治疗后视网膜及视神经乳头(ONH)的血流变化,并进行比较。在这项前瞻性横断面研究中,使用平均模糊率(MBR)通过激光散斑血流图对39例S-NPDR患者的39只眼在全视网膜光凝(PRP)术前、术后1周、4周、8周、12周时的视网膜及ONH血流进行评估。39只眼中,17只眼的17例患者接受传统激光治疗,22只眼的22例患者接受PASCAL治疗。传统激光治疗组平均年龄为55.5±11.5岁,PASCAL治疗组平均年龄为55.6±11.8岁。MBR-血管主要代表视网膜血流,传统激光治疗的PRP术后显著降低(P<0.001),而PASCAL治疗的PRP术后无变化。仅在第1周时,传统激光治疗组的MBR-血管与基线的比值显著较低(P=0.045)。MBR-组织主要代表ONH血流,两组PRP术后均无显著变化。多元逐步回归分析显示,激光光斑是与第1周时MBR-血管与基线比值显著相关的独立因素(β=-0.550,P=0.012)。仅在传统激光治疗完成PRP后的12周内,视网膜血流显著降低。我们的结果表明,PASCAL进行的PRP短脉冲治疗不会显著降低视网膜血流。